COI_ADOA_-_Bus-Prof_Liability_-_Marlene_Imirzian.pdf
PDF 206 KB Posted
- Attached to
- Master Agreement AZ|CTR076530
- Contract number
- CTR076530
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Marlene Imirzian & Associates, LLC, issued by RLI Insurance Company through Professional Insurance Brokers, Inc. The certificate is for a contract (Contract No. CTR076530) with the Arizona Department of Administration (ADOA) for On-Call Architectural Services. The insurance covers the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds.
The insurance policy provides comprehensive coverage including Commercial General Liability ($1,000,000 per occurrence), Automobile Liability ($1,000,000), Umbrella Liability ($2,000,000 per occurrence), and Professional Liability ($3,000,000 per claim / $4,000,000 aggregate). The policy is effective from 08/01/24 to 08/01/25, with a 30-day cancellation notice. The coverage includes primary and non-contributory protection, separation of insureds, and a waiver of subrogation as specified in the contract. The insurance applies to on-call architectural services, with specific endorsements detailing the scope and limitations of the coverage.
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Text version
04/16/25
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT
BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER: CAROL GRAY LANTZ
PROFESSIONAL INSURANCE BROKERS, INC. 623 465-5300 623 465-5933
PMB 857, 515 E. CAREFREE HWY
carol@pibinc.com
PHOENIX, ARIZONA 85085-8839
R L I INSURANCE COMPANY 13056
MARLENE IMIRZIAN & ASSOCIATES, LLC
8906 NORTH CENTRAL AVENUE
PHOENIX, ARIZONA 85020
COVERAGES: CERTIFICATE NUMBER: 29 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR LIMITS
A X COMMERCIAL GENERAL LIABILITY $ 1,000,000
CLAIMS MADE X X X PSB0003650 08/01/24 $ 1,000,000
$ 10,000
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: $ 2,000,000
X LOC $ 2,000,000
OTHER
A AUTOMOBILE LIABILITY $ 1,000,000
ANY AUTO SCHEDULED X X PSB0003650 08/01/24
AUTOS $
NON $
OWNED $
AUTOS
A X UMBRELLA LAB EACH OCCURRENCE $ 2,000,000
X X PSE0002484 08/01/24 AGGREGATE $ 2,000,000
DED RETENTION $ $
Y/N
N/A $
A EACH CLAIM / AGGREGATE
X PROFESSIONAL LIABILITY X RDP0055205 08/01/24 3,000,000 / 4,000,000
Contract No. CTR076530 for ADOA On-Call Architectural Services
As per written contract, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insured, on a primary and non-contributory basis, as respects General and Automobile Liability coverage per Form PPB3040212 attached.
Separation of insureds applies to General Liability coverage as per policy form. Waiver of subrogation applies to all listed policies as per written contract.
30 day notice of cancellation applies.
CERTIFICATE HOLDER CANCELLATION
Arizona Department of Administration General Services Division 1400 W. Washington, Suite B200 Phoenix, AZ 85007
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD.
08/01/25
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CLAIMS-MADE
WORKERS COMPENSATION AND
EMPLOYERS’ LIABILITY ANY
PROPRIETOR/PARTNER EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under
DESCRIPTION OF OPERATIONS BELOW
PER STATUTE
OTHER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
X
HIRED
AUTOS
PROPERTY DAMAGE (Per accident)
EXCESS LIAB OCCUR 08/01/25
COMBINED SINGLE LIMIT (Ec
Accident)08/01/25
ALL
OWNED
AUTOS
BODILY INJURY (Per person)
X
BODILY INJURY (Per accident)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
POLICY PROJECT PRODUCTS.COMP/OP AGG
POLICY EXP.
DATE(MM/DD/YY) DATE(MM/DD/YY)
EACH OCCURRENCE
OCCUR 08/01/25 DAMAGE TO RENTED PREMISES
(Ec occurrence)
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVO
POLICY NUMBER
POLICY EFF.
ADDRESS:
PRODUCER
CUSTOMER ID:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED: INSURER A:
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CONTACT
NAME:
PHONE
(A/C.No. Ext):
FAX (A/C
No)
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